Early Results of Using the Bovine Jugular Vein for Right Ventricular Outflow Reconstruction during the Ross Procedure
DOI:
https://doi.org/10.1532/hsf.957Abstract
Objective: To study the early function of the bovine jugular vein (BJV) when used for right ventricular outflow tract (RVOT) reconstruction during the Ross procedure.
Methods: Seventeen consecutive patients (median age, 12 years; range, 30 days to 40 years) who had undergone a Ross procedure with RVOT reconstruction using a BJV were reviewed. Nine patients had prior balloon valvotomy (n = 6) and/or surgical aortic valvotomy (n = 4). Additional procedures included a reduction-plasty of the ascending aorta (5 patients), a Konno procedure (2 patients), a mitral valve repair/replacement (2 patients), and others (3 patients). The size of the BJV ranged from 12 to 22 mm (median, 20 mm).
Results: There were no early or late deaths. None of the patients encountered any significant postoperative complications. The neo-aortic valve showed good function in all patients with no more than trivial insufficiency. At a median follow-up period of 11 months, the frequency of freedom from BJV graft dysfunction/reintervention/reoperation was 100%. One patient had moderate insufficiency of the BJV in a perioperative examination that regressed to mild insufficiency during follow-up. Overall, none of the patients had more than mild insufficiency at follow-up. Four patients showed a flow acceleration of more than 250 cm/s (equivalent to a gradient of 25 mm Hg) across the BJV, and the remaining patients had lower gradients.
Conclusions: The BJV, when used to replace the pulmonary valve in the Ross procedure, showed excellent function in the early phase. The large size range and easy availability of this valved conduit are particularly attractive. Further followup is needed to determine the long-term results of its use.
References
Kouchoukos NT, Davila Roman VG, Spray TL, Murphy SF, Perrillo JB. 1994. Replacement of the aortic root with a pulmonary autograft in children and young adults with aortic-valve disease. N Engl J Med 330:1-6.nOury JH. 1998. Invited commentary on the Ross procedure. J Card Surg 13:171-2.nRoss DN. 1967. Replacement of aortic and mitral valves with a pulmonary autograft. Lancet 2:956-8.nSimon P, Kasimir MT, Seebacher G, et al. 2003. Early failure of the tissue engineered porcine heart valve SYNERGRAFT in pediatric patients. Eur J Cardiothorac Surg 23:1002-6.nYankah AC, Alexi-Meskhishvili V, Weng Y, Schorn K, Lange PE, Hetzer R. 1995. Accelerated degeneration of allografts in the first two years of life. Ann Thorac Surg 60:S71-7.nAlbert JD, Bishop DA, Fullerton DA, Campbell DN, Clarke DR. 1993. Conduit reconstruction of the right ventricular outflow tract: lessons learned in a twelve-year experience. J Thorac Cardiovasc Surg 106:228-35.nBove T, Demanet H, Wauthy P, et al. 2002. Early results of valved bovine jugular vein conduit versus bicuspid homograft for right ventricular outflow tract reconstruction. Ann Thorac Surg 74:536-41.nCorno AF, Goy JJ, Hurni M, Payot M, Sekarski N, von Segesser LK. 2001. Treatment of congenital aortic valve stenosis: impact of the Ross operation. Swiss Med Wkly 131:65-9.nElkins RC, Knott Craig CJ, Ward KE, Lane MM. 1998. The Ross operation in children: 10-year experience. Ann Thorac Surg 65:496-502.nElkins RC, Lane MM, McCue C. 2001. Ross operation in children: late results. J Heart Valve Dis 10:736-41.nIchikawa Y, Noishiki Y, Kosuge T, Yamamoto K, Kondo J, Matsumoto A. 1997. Use of a bovine jugular vein graft with natural valve for right ventricular outflow tract reconstruction: a one-year animal study. J Thorac Cardiovasc Surg 114:224-33.n
